| California Liberty Medical Group | |
|
8426 California Ave South Gate CA 90280 | |
| (323) 564-5805 | |
| (323) 564-1670 |
| Full Name | California Liberty Medical Group |
|---|---|
| Speciality | Pediatrics |
| Location | 8426 California Ave, South Gate, California |
| Authorized Official Name and Position | Thanh N Tran (PRESIDENT DIRECTOR) |
| Authorized Official Contact | 3235645805 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| California Liberty Medical Group 8426 California Ave South Gate CA 90280 Ph: (323) 564-5805 | California Liberty Medical Group 8426 California Ave South Gate CA 90280 Ph: (323) 564-5805 |
| NPI Number | 1528101847 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528101847 | NPI | - | NPPES |
| GR0055100 | Other | MEDICAL PROVIDER GROUP | |
| 00A403260 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A7502 (California) | Primary |
| 207Q00000X | Family Medicine | A75777 (California) | Primary |
| 208000000X | Pediatrics | A40326 (California) | Primary |
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